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FORMULARY FORUM

Tinzaparin: Considerations for Use in Clinical Practice

Clinical Assistant Professor, Director, Antithrombosis Service, Department of Pharmacy Practice, College of Pharmacy, The University of Illinois at Chicago, Chicago, IL

Nancy L Shapiro, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, The University of Illinois at Chicago

Helen Feinstein

PharmD Student, College of Pharmacy, The University of Illinois at Chicago

Christina W Rivers, PharmD

Clinical Pharmacist — Ambulatory Care, Edward Hines Jr Veterans Affairs Medical Center, Hines, IL

Reprints: Edith A Nutescu PharmD, Department of Pharmacy Practice, College of Pharmacy, The University of Illinois at Chicago, 833 S. Wood St., M/C 886, Rm. 164, Chicago, IL 60612-7230, FAX 312/413-4805, enutescu{at}uic.edu

OBJECTIVE: To evaluate the safety and effectiveness of tinzaparin for the prevention and treatment of venous thromboembolism (VTE).

DATA SOURCES: A MEDLINE and PubMed database search (1980–December 2002) was conducted. Only articles written in English were reviewed.

STUDY SELECTION AND DATA EXTRACTION: Articles reporting the safety, efficacy, and cost-effectiveness of tinzaparin in humans were evaluated. Emphasis was placed on randomized, controlled trials.

DATA SYNTHESIS: Tinzaparin sodium is a low-molecular-weight heparin (LMWH) that exerts its anticoagulant effect through inhibition of factors Xa and IIa and release of tissue factor pathway inhibitor from the vascular epithelium. Tinzaparin is indicated for treatment of acute symptomatic deep-vein thrombosis (DVT), with or without pulmonary embolism. Clinical studies suggest that tinzaparin is also effective for VTE prophylaxis, as well as other indications. Once-daily subcutaneous tinzaparin is equally or more effective than intravenous unfractionated heparin (UFH) for prevention and treatment of VTE, at least as safe as UFH for bleeding complications, and requires little or no monitoring. No dose "cap" is required for obese patients, and no initial dosing adjustments are necessary in elderly and/or renally impaired patients, although some monitoring is recommended. The few comparative data available suggest that tinzaparin efficacy may be comparable to that of other LMWHs; more comparative studies are needed. Pharmacoeconomic studies indicate a favorable cost–benefit ratio.

CONCLUSIONS: Tinzaparin is safe and effective for prevention and treatment of DVT. Consistent once-daily dosing may facilitate self-administration of tinzaparin in the outpatient setting.

Key Words: anticoagulants, antithrombotic agents, low-molecular-weight heparin, tinzaparin

Published Online, November 5, 2003. www.theannals.com, DOI 10.1345/aph.1D221

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-039-H01

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